NR601:Week 3: Psychiatric Disorders

Published by Brenda I. Belcher

Jul 14, 2021

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Week 3: Psychiatric Disorders and Screening

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Purpose 

The purpose of student discussions is to provide the opportunity for application of depression and anxiety screening tools to a selected case patient.   

Activity Learning Outcomes 

Through this discussion, the student will demonstrate the ability to: 

  1. Explain the purpose of two selected screening tools (CO7)
  2. Interpret the scoring criteria of two selected screening tools (CO7)
  3. Discuss the mechanism of action, side effects and expected onset of action for a selected medication (CO4)

Due Date:   

The initial posting to the graded collaborative discussions is due by Wednesday, 11:59 p.m. MT.   

Peer responses and responses to faculty must be posted prior to the week deadline of Sunday 11:59 MT.   

 A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).

Total Points Possible70

Requirements: 

Anxiety and depression are the most common psychiatric problems you will encounter in your primary care practice. 

Review this case study 

HPI: KF, 56-year-old Caucasian female presents to office with complaints of “no energy and not wanting to go out.” These symptoms have been present for about 3 months and seem worse in the morning and improve slightly through the day. It is hard to get out of bed and get the day started because does not feel rested when she wakes up in the morning.  KF reports a “loss of joy”. States” I really don’t feel like going anywhere or doing anything”.  She tries to do at least one social activity a week, but it can be really exhausting. Reports she also has difficulty completing projects for work, she cannot stay focused anymore. She reports not feeling hungry, so she is not eating regularly and has lost some weight.  KF has been a widow for 2 years. Her husband died unexpectedly, he had a MI. She recently got a puppy, which she thought would help with the loneliness, but the care of the puppy seems overwhelming at times. Rest and exercise, specifically yoga and meditation seem to help her feel better. At this time, she does not want to do either, it seems like too much effort to get up and go. She has not tried any medications, prescribed or otherwise. She reports drinking a lot of coffee, but that does not seem to help with her energy levels.  

Current medications: Excedrin PM about once a week when she can’t sleep, seems to help a bit. NKDA.  

PMH: no major illnesses. Immunizations up to date.  

SH: widowed, employed full time as a consultant. Drinks 1 glass of wine almost every night. No tobacco use, no illicit drug use. Previously married 20 years ago while living in France, reports an abusive relationship. The French government gave custody of her son to the ex-husband. She returned to US without her son 10 years ago. She sees her son two times a year, they skype and text “all the time” but she misses him. Her son is now an adult and is considering moving to the US.   

FH: Parents are alive and well. Has one son, age 21, he is healthy but lives in France with his father. 

ROS  

CONSTITUTIONAL: reports weight loss of 4-5 pounds, no fever, chills, or weakness reported. Daily fatigue.   

HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclera. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.  

CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.  

RESPIRATORY: No shortness of breath, cough or sputum.  

GASTROINTESTINAL: Reports decreased appetite for about 3 months. No nausea, vomiting or diarrhea. No abdominal pain or blood.  

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.  

GENITOURINARY: no burning on urination. Last menstrual period 4 years ago.  

PSYCHIATRIC: No history of diagnosed depression or anxiety. Reports history of great anxiety due to verbal and concern for physical abuse, reports feeling very sad and anxious when divorcing and leaving her son in France. Did not seek treatment. She started to feel better after about 4 months.  

ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia  

ALLERGIES: No history of asthma, hives, eczema or rhinitis.  

Discussion Questions:  

  1. Research screening tools for depression and anxiety. Choose one screening tool for depression and one screening tool for anxiety that you feel are appropriate to screen KF.
  2. Explain in detail why each screening tool was chosen. Include the purpose and time frame of each chosen tool.
  3. Score KF using both of your chosen screening tools based on the information provided (not all data may be provided, those areas can be scored as not present). Pay close attention to the listed symptom time frame for your chosen assessment tool.  In your response include what questions could be scored, and your chosen score.  Interpret the score according to the screening tool scoring instructions. Assume that any question topics not mentioned are not a concern at this time.
  4. Identify your next step for evaluation and treatment for KF. Remember to consider both physical and mental health differential diagnoses when answering this question.   (2-3 sentences).
  5. What medication or treatment is appropriate for KF based on her screening score today? Provide the rationale. Any medications should include the medication class, mechanism of action of the medication and why this medication is appropriate for KF. Include initial prescribing information.  
  6. If the medication works as expected, when should KF expect to start feeling better? 
DISCUSSION CONTENT  Category  Points  %  Description  Application of Course Knowledge    21   30  Initial discussion post includes the following:  1) two screening tools chosen- 1 for depression, one for anxiety  2)  Student explains rationale for both screening tool choices (2-3 sentences)   3) both screening tools are scored using provided case study information only AND scores are interpreted using tool scoring guidelines.  4) Next steps for treatment includes physical health diagnoses and suggested necessary diagnostics  5) Medication choice is listed. Rationale includes medication class, mechanism of action and initial prescribing information and education to include side effects and when KF should notice efficacy.  Support from Evidence-Based Practice (EBP)   14  20   1. Discussion post is supported with appropriate, scholarly sources; AND    2. Sources are published within the last 5 years ; AND   3. Reference list is provided and in-text citations match; AND   4. Includes a minimum of one scholarly reference, textbook is not used  Interactive Dialogue   21  30   1. Student provides a substantive* response to at least one topic-related post of a peer; AND   2. Student provides a substantive response to any faculty questions asked regarding the initial student post.    3. Evidence from appropriate scholarly sources are included;    4. Submits a minimum of two posts on two different days.   (*) A substantive post adds new content or insights to the discussion thread and information from student’s original post is not reused in peer or faculty response     56  80%  Total CONTENT Points= 56 points  DISCUSSION FORMAT  Category  Points  %  Description  Organization   7  10   1) Discussion is presented in a logical format, AND   2) Responses are in sequence with the listed bullet points AND   3) The discussion response is understandable and easy to follow AND  4) All responses are relevant to the discussion  topic.     Grammar, Syntax, Spelling & Punctuation   7  10   Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors*       14  20%  Total FORMAT Points= 14 points        DISCUSSION TOTAL=____ out of  70 points  

Direct Quotes

Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.

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